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Individual
GAYLE GREEN
Active
Individual
GAYLE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
2084N0400X
Neurology Physician
2084N0400X
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XYK991439774
BLUE CARE NETWORK OF MICHIGAN
MI
Enumeration date
01/11/2019
Last updated
01/14/2019
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